| NPI | 1679040901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO60749434) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60832062) |
| Enumeration Date | 2018-10-24 |
| Last Update Date | 2019-11-08 |